Fetal Medicine

In the specialty of Fetal Medicine, we primarily work with the Karolinska University Hospital. The Center for Fetal Medicine at Karolinska University Hospital is the largest fetal therapy center in the Nordic-Baltic area. They have a broad experience in the diagnosis and management of pregnancies with congenital malformations, fetal anemia, rare conditions and complications in multiple pregnancies. They work as a multidisciplinary team of experts focusing on the need of the individual patient. The team consists of fetal medicine experts, fetal surgeons, pediatric specialists, clinical geneticists, transfusion medicine specialists, genetic counselor, midwives and social workers.

Specific areas of expertise include:

Fetal anemia and intrauterine blood transfusions

The center is established as a center of excellence in the management of red cell immunization and treatment of hemolytic disease of the fetus and newborn. In collaboration with pediatric hematologists, they diagnose and treat all kinds of fetal anemia and perform about 60 intrauterine blood transfusions per year with excellent results.

Twin to Twin Transfusion Syndrome -TTTS

The center performs fetoscopic laser surgery for TTTS in multiple pregnancy since 2001. They treat TTTS between gestational age of 15 to 28 weeks of pregnancy with overall perinatal survival rates of 75 percent ( at least one surviving baby in 90% and two in 65% of twin pregnancies).

sIUGR - Selective Intrauterine Growth Restriction

The team has a large experience in evaluating and counselling in selective growth restriction in monochorionic twins and triplets. If indicated and according to the parent´s wish, they perform interventions such as fetoscopic laser coagulation of placental anastomoses, bipolar cord occlusion and intrafetal laser coagulation.

TAPS - Twin Anemia Polycytemia Sequence

The center evaluate and treat both spontaneous TAPS and TAPS occurring after laser surgery for TTTS with excellent perinatal outcomes.

Discordant congenital malformations in monochorionic twins or triplets

They offer evaluation, confirmation of diagnosis and prognosis in multiple pregnancies affected by discordant congenital malformations in any of the fetuses. If indicated, they perform selective reduction with bipolar cord occlusion, intrafetal laser, potassium chloride injection or radiofrequency ablation.

TRAP - Twin Reversed Arterial Perfusion sequence

If diagnosed in the first trimester, intrafetal laser coagulation is preferably performed and in later gestation radiofrequency ablation, for TRAP cases.

Fetal shunt procedures

In severe hydrothorax, punction of the pleural cavity and placement of pleuroamniotic shunts can be life-saving and significantly improve the chance of perinatal survival of the baby. Especially if there is hydrops fetalis or a high risk of development of hydrops.

In well informed and selected cases, the Center for Fetal Medicine team also place vesicoamniotic shunts to treat urethral valves (Lower Urinary Tract Obstruction (LUTO)/megacystis) in male fetuses.

EXIT – Ex Utero Intrapartum Treatment

The center has a well-trained multidisciplinary team consisting of fetal medicine experts, obstetricians, neonatologists, anesthesiologists, ENT surgeons, pediatric surgeons and specialized nurses performing EXIT deliveries of fetuses with life-threatening tumors in the head neck area or with laryngeal atresia (CHAOS syndrome).

Congenital Diaphragmatic Hernia

Karolinska University Hospital is one of the two national reference centers for the care of newborns with congenital diaphragmatic hernia and has a well renowned pediatric ECMO service. From 2020 the center offers prenatal fetsocopic tracheal occlusion, as early fetal treatment of severe cases of diaphragmatic hernia.

Skeletal dysplasias

Pregnancies with uncommon skeletal dysplasias are evaluated multidisciplinary with the

Karolinska European Reference Network group (ERN) that has broad clinical experience in the diagnosis and management of rare skeletal dysplasias and congenital syndromes.

Gastroschisis and omphalocele

Abdominal wall defects are managed multidisciplinary together with pediatric surgeons and time and mode of delivery is customized to secure optimized outcomes following postnatal surgery.

Cloacal malformations, anal and esophageal atresia

Cloacal malformations, anal and esophageal atresia in newborns are diagnoses where Karolinska is one of the two national centers for counselling and postnatal surgical treatment.

CNS malformations

The unit has experience in advanced diagnosis of brain anomalies with both high resolution ultrasound and fetal MRI examinations, that are assessed together with neuroradiologists. Pregnancies with spina bifida can be evaluated, counselled and treated postnatally by pediatric neurosurgeons with open surgery or referred for fetal surgery in European centers.

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